Medical support device

ABSTRACT

There is provided a medical support device for holding and positioning a needle. This device is particularly useful for positioning needles in a less invasive puncture treatment. This device comprises two rotational elements and at least one needle guide attached to a rotational element and. The needle guide guides the direction of insertion of a needle-like instrument and includes a guide portion that guides a needle or other needle-like instrument where the puncture point of the needle in a first position is different from the puncture point when the needle guide guides the needle in a second position.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention relates to a medical support device for holdingand positioning a needle. More specifically, the present inventionrelates to positioning of one or more needles in a puncture treatment.

Description of the Related Art

In medical treatment, in order to improve the QOL (quality of life) ofthe patient, the need for less invasive treatment is increasing. In sucha situation, percutaneous puncture treatments such as percutaneouspuncture ablation and percutaneous puncture cryosurgery have beendeveloped as less invasive treatments.

However, in the case of percutaneous puncture treatment, the puncturetarget site is not directly visible, and therefore puncture needs to beperformed on the basis of a medical image obtained using an MRI machine,a CT machine, or the like. However, since these medical imaging machinesare used, an image cannot be obtained in real time. Although an imagecan be obtained in real time by using a special MRI machine, in thatcase, the work need to be performed in a narrow space. In both cases, itis difficult to precisely reach the target, and therefore the operationtakes time.

In such a situation, a puncture-supporting mechanism shown in U.S. Pat.Pub. 2011/0190787 has been proposed as medical support using a medicalimage obtained using an MRI machine, a CT machine, or the like.According to U.S. Pat. Pub. 2011/0190787, a marker attached to a deviceis recognized on a medical image, and the attitude of the device isfound. On the basis of this attitude and the position of the puncturetarget, the direction and depth of puncture may be determined andpuncture is supported. In the case of this mechanism, a needle can beinserted through the same insertion point toward different puncturetargets, and therefore the trauma due to puncture is minimized. Inaddition, the mechanism can be reduced in size, and a patient can enteran existing medical imaging machine with the device attached to them.

Operative methods performed in a state where instruments are inserted ata plurality of different target positions are increasingly used as apercutaneous puncture treatment.

However, when an operator tries to insert instruments at a plurality ofdifferent target positions, as the case of the configuration disclosedin U.S. Pat. Pub. 2011/0190787, the instruments are inserted through thesame insertion point unless the installation position is changed. Forthis reason, when the operator tries to insert the second and subsequentinstrument(s), the instruments interfere with each other, and insertionof more than one instrument cannot be performed.

In U.S. Pat. Pub. 2005/0080333, insertion of a plurality of instrumentsat different target positions is achieved using a grid-like positioningunit. However, a dedicated conveying bed is needed, therefore the deviceis large, and use in an existing imaging machine is difficult.

In view of such problems, it is desired to avoid interference betweeninstruments with a simple mechanism. Thus, there is need for a devicethat can be used with multiple instruments (such as needles) where theinstruments can be placed at the target sites with little to nointerference between the instruments without the need to re-install thedevice on the patient.

SUMMARY OF THE INVENTION

A medical support device is provided that comprises: a first rotationalelement having a first rotation axis and a first rotational degree offreedom; a second rotational element having a second rotation axis and asecond rotational degree of freedom that is attached to the firstrotational element wherein the second rotation axis intersects with thefirst rotation axis; and at least one needle guide that is attachable tothe second rotational element and is configured to guide the directionof insertion of a needle-like instrument. In this device, the at leastone needle guide includes at least one guide portion that guides a firstneedle-like instrument through a first puncture starting point andguides a second needle-like instrument through a second puncturestarting point which is different from the first puncture startingpoint, wherein, the at least one needle guide is in a first positionwhen guiding the first needle-like instrument and in a second positionwhen guiding the second needle-like instrument, or a first needle guideincludes a first guide portion that guides a needle-like instrumentthrough the first puncture starting point and a second needle guideincludes a second guide portion that guides a needle-like instrumentthrough the second puncture starting point.

Some embodiments provide a medical support device, comprising: at leastone rotatable portion having at least one rotational degree of freedomand at least one needle guide attached to the rotatable portion andhaving a guide portion, which is configured to: (a) guide the directionof insertion of a needle-like instrument and (b) separate from theneedle-like instrument after insertion of the needle-like instrument,wherein the guide portion, when the needle guide is positioned in afirst position, is configured to guide the needle-like instrument to afirst puncture starting point wherein the guide portion, when the needleguide is positioned in a second position, or wherein the guide portionof a second needle guide is configured to guide the needle-likeinstrument to a second puncture starting point which is different fromthe first puncture starting point.

Other embodiments provide a method comprising: attaching a medicalsupport device to a patient, wherein the medical support devicecomprises a first rotational element, second rotational element, and atleast two needle guides, defining at least a first location and a secondlocation in the patient for therapeutic intervention based on an imagedata, attaching a first needle to a first needle guide, attaching thefirst needle guide to the medical support device, instructing themedical support device to rotate the first rotational element and thesecond rotational element to a position defined by the first locationfor therapeutic intervention, inserting the first needle into thepatient, releasing the first needle from the medical support device,attaching a second needle to a second needle guide and attaching thesecond needle guide to the medical support device, instructing themedical support device to rotate the first rotational element and thesecond rotational element to a position defined by the second locationfor therapeutic intervention, inserting the second needle into thepatient, wherein the second needle does not contact the first needleduring insertion into the patient, and releasing the second needle fromthe medical support device.

BRIEF DESCRIPTION OF THE DRAWINGS

Further objects, features and advantages of the present invention willbecome apparent from the following detailed description when taken inconjunction with the accompanying figures showing illustrativeembodiments of the present invention.

FIG. 1 shows the schematic configuration of a mechanical portion of afirst embodiment.

FIG. 2 shows the schematic configuration of the first embodiment.

FIGS. 3A, 3B, and 3C show three views of a first example of a needleguide. FIG. 3A is a front view. FIG. 3B is a plan view. FIG. 3C is aperspective view.

FIGS. 4A, 4B, and 4C show three views of a second example of a needleguide. FIG. 4A is a front view. FIG. 4B is a plan view. FIG. 4C is aperspective view.

FIGS. 5A and 5B show the state of needles during puncture.

FIG. 6 shows the schematic configuration of a mechanical portion of asecond embodiment.

FIG. 7 is a schematic sectional view of the mechanical portion of thesecond embodiment.

FIG. 8A is a block diagram of the second embodiment. FIG. 8B is a blockdiagram of the first embodiment.

FIG. 9 is a block diagram of a computer system as described here.

FIGS. 10A, 10B, and 10C show a first needle guide mechanism having adegree of freedom.

FIGS. 11A, 11B, and 11C show three views of a second needle guidemechanism having a degree of freedom. FIG. 11A is a front view. FIG. 11Bis a plan view. FIG. 11C is a side view.

FIGS. 12A, 12B, and 12C show three views of a third needle guidemechanism having a degree of freedom. FIG. 12A is a front view. FIG. 12Bis a plan view. FIG. 12C is a side view.

FIG. 13 shows the schematic configuration of a mechanical portion of athird embodiment.

FIG. 14 shows a cut away view of the schematic configuration of amechanical portion of a third embodiment.

FIG. 15A-15C each shows schematic configurations of a mechanical portionof a fourth embodiment.

FIG. 16 shows a cut away view of the schematic configuration of amechanical portion of a fifth embodiment.

FIG. 17 shows a cut away view of the schematic configuration of amechanical portion of a fifth embodiment.

FIG. 18A is a schematic showing the cone-shaped volume a needle-likeinstrument can pass through during rotation of the medical supportdevice. FIG. 18B is a schematic showing cone-shaped volume for twoneedle-like instruments where the height of the needle guides aredifferent. FIG. 18C is schematic showing cone-shaped volumes for twoneedle-like instruments where the angle of the needle guides aredifferent.

In the following description, reference is made to the accompanyingdrawings which are illustrations of embodiments in which the disclosedinvention may be practiced. It is to be understood, however, that thoseskilled in the art may develop other structural and functionalmodifications without departing from the novelty and scope of theinstant disclosure.

DESCRIPTION OF THE EMBODIMENTS First Embodiment Configuration

A first embodiment of the present invention will be described withreference to FIG. 1, FIGS. 5A and 5B, and FIG. 6 to Fig. First, theschematic configuration of a mechanical portion of a medical supportdevice of this embodiment will be described with reference to FIG. 1.

Mechanical Configuration

In FIG. 1, the structure of a movable portion in each rotationalelement, or rotational element is omitted for simplification. First, abase 15 of a mechanical portion 1 is fixed and installed on an object tobe punctured with a fixing unit (not shown).

A stationary portion of an annular, or ring shaped first rotationalelement 11 (also defined as a rotation mechanism) is attached to thebase 15.

Next, a stationary portion of an arcuate second rotational element 12(also defined as a rotation mechanism) is attached to a movable portionof the rotational element 11. At this time, the rotational element 11and the rotational element 12 are configured such that, as shown in FIG.2, the rotation axis 22 of the second rotational element 12 thatrepresents the center of rotation of a movable portion of the secondrotational element 12 is perpendicular to the rotation axis 21 of thefirst rotational element 11 that represents the center of rotation ofthe movable portion of the first rotational element 11.

A needle guide 13 is attached to the movable portion of the secondrotational element 12.

The needle guide 13 has a cutout. By inserting a needle-like instrument10 along the cutout, the insertion direction of the instrument 10 isguided.

The first rotational element 11 and the second rotational element 12 areoptionally provided with scale-like position detection units 6 a and 6b, with which the rotation angle of each rotational element can bedetected.

Thus, in use, the medical support device is positioned on an object suchas a human torso and the two rotational elements are rotated to definean optimal or predefined trajectory for a needle like element wheninserted along the cut-out of the needle guide.

Detailed Description of Each Mechanism

The arrangement of degree of freedom of each rotational element of themechanical portion 1 and the range of movement thereof will be describedwith reference to FIG. 2.

In FIG. 2, the needle guide 13 and the position detection units 6 a and6 b are omitted for simplification. The needle-like instrument 10 isalso omitted. Instead, a straight line 20 showing the direction of theinstrument is depicted.

First, how coordinate axes are defined in this embodiment will bedescribed. The XZ plane is defined as a plane containing the bottomsurface of the mechanical portion, and the Y-axis is defined as an axisperpendicular to the XY plane. Hereinafter, a coordinate (x, y, z) showsthe values of the X-axis, Y-axis, and Z-axis.

The movable portion of the first rotational element 11 is arranged suchthat the rotation axis 21 is perpendicular to the bottom surface. InFIG. 2, the movable portion of the first rotational element 11 isarranged such that the rotation axis 21 coincides with the Y-axis. Inthis embodiment, the movable portion of the first rotational element 11is rotatable at least ±180 degrees.

Next, the movable portion of the second rotational element 12 isarranged such that the rotation axis 22 is perpendicular to the rotationaxis 21 of the first rotational element 11. In FIG. 2, the movableportion of the second rotational element 12 is arranged such that therotation axis 22 coincides with the Z-axis. However, the rotation axis22 is not fixed. When the movable portion of the first rotationalelement 11 is rotated an arbitrary angle, the rotation axis 22 is alsorotated. For example, when the first rotational element 11 is rotated 90degrees, the rotation axis 22 coincides with the X-axis.

When 0 degrees is defined as a position corresponding to the Y-axis, themovable portion of the second rotational element 12 is rotatable in bothpositive and negative directions with respect thereto.

Needle guides 13 facing in different directions as shown in FIGS. 3A to3C and FIGS. 4A to 4C are interchangeable with each other. Thus, severalneedle guides with the configuration of FIG. 3 and/or FIG. 4 may bepositioned on the needle guide. FIG. 3A and FIG. 4A are front views,FIG. 3B and FIG. 4B are plan views, and FIG. 3C and FIG. 4C areisometric views. The needle guide 13 b shown in FIGS. 4A to 4C isprovided with a cutout so as to guide a needle-like instrument 10 in adirection that does not pass through the intersection 23 of the rotationaxis 21 of the first rotational element 11 and the rotation axis 22 ofthe second rotational element 12.

On the other hand, the needle guide 13 a shown in FIGS. 3A to 3C isprovided with a cutout so as to guide a needle-like instrument 10 in adirection that passes through the intersection 23 of the two rotationaxes.

In this embodiment, for simplification, a description will be given of acase where only the needle guide 13 b shown in FIGS. 4A to 4C is used.Similarly in FIG. 4, the needle guides can be formed with a differentangle for the cutout. This provides for needle guides that will guide aneedle to an entry point having a different proximity to theintersection of the rotation axis of the two rotational elements.

In some embodiments, as shown in FIGS. 3 and 4, the cutout of the needleguide is triangular in shape. In other embodiments the cutout is asemicircle, square, rectangular, or having some other shaped. In otherembodiments, instead of a cutout as described herein, the needle guide13 may contain a through-hole that can be used to guide the needle. Insome embodiments, in addition to a cutout, an additional element may beincorporated as part of the needle guide. This additional element may beconfigured to hold and then release the needle after positioning, to,for example, allow a patient to resume breathing after needle placement.

Operation

FIG. 8B is a block diagram showing a system configuration, including auser, in this embodiment. The operation of each block and input andoutput signals in this embodiment will be described with reference toFIG. 8B.

The user specifies a plurality of target positions in the coordinatesystem of the medical support device via an input device 200.

An angle calculation unit 2 finds two combinations of target angles ofthe two rotational elements for each of the input target positions, andoutputs them to an interference analysis unit 3. For example, when twotarget positions Pa (xa, ya, za) and Pb (xb, yb, zb) are input,combinations of target angles (θa1, θa2) and (θa1′, θa2′) for the targetposition Pa are output. Combinations of target angles (θb1, θb2) and(θb1′, θb2′) for the target position Pb are output.

In some embodiments, the target positions are input as coordinates. Inother embodiments, the target positions are provided by the user byindicating the position directly on a tomographic medical image (e.g.,via a touch or a pointing device).

The calculation may be a calculation of general inverse kinematics, sothe description thereof will be omitted.

The interference analysis unit 3 finds the equations of straight lines20 showing the directions in which needle-like instruments 10 areinserted, from the combinations of target angles input from the anglecalculation unit 2. Then, the interference analysis unit 3 finds thedistances between straight lines to different targets from the foundequations of straight lines.

For example, the interference analysis unit 3 finds the equations ofstraight line La and straight line La′ from the combinations of targetangles (θa1, θa2) and (θa1′, θa2′), and finds the equations of straightline Lb and straight line Lb′ from the combinations of target angles(θb1, θb2) and (θb1′, θb2′).

Then, the interference analysis unit 3 selects the combination that islargest in distance between straight lines from four combinations La-Lb,La-Lb′, La′-Lb, and La′-Lb′. In this embodiment, La-Lb is selected. Theselected combination of target angles is presented on a presentationportion 4.

Presentation portion 4 may be, for example, a display unit such as amonitor, and it may be integrated into the display of the medial image.Alternatively, the presentation portion may be, for example, a smalldisplay located on the device.

At this time, the calculation performed in the interference analysisunit 3 is a general calculation for finding the distance between twostraight lines in a three-dimensional space, so the detailed descriptionthereof will be omitted.

The user optionally confirms the target angles presented on thepresentation portion 4, and rotates the first rotational element 11 inFIG. 1 and the second rotational element 12 in FIG. 1 manually such thatthey are at the presented target angles. At this time, the user changesthe position of the first rotational element 11 and the secondrotational element 12 manually by referring the position detection units6 a and 6 b provided on the rotational elements 11 and 12. Inalternative embodiments, the positioning of rotational elements 11 and12 is automated and the presentation portion is optional.

As a result, the needle guide 13 faces the target position Pa. Byinserting a needle-like instrument 10 a along the cutout of the needleguide 13 in this attitude, the instrument can be inserted at the targetposition Pa as shown in FIG. 5A.

Next, in order to puncture the target position Pb, with the instrument10 a remaining inserted, as with the target position Pa, the movableportions of the rotational elements are moved such that the rotationalelements 11 and 12 are at the target angles θb1 and θb2 thereof.

As a result, the needle guide 13 faces the target position Pb. Byinserting a needle-like instrument 10 b along the cutout of the needleguide 13 in this attitude, the instrument can be inserted at the targetposition Pb.

Thus, as shown in FIG. 5B, needle-like instruments 10 are inserted atboth the target position Pa and the target position Pb.

FIG. 9 illustrates an example of hardware of the computing unit 100. Aprocessor 101 reads and executes a program code stored in a hard diskdevice 103 to execute a various type of process and control. A ram 102temporarily stores information pieces, such as a program code executedby the processor 101. The hard disk device 103 stores a program code anda various type of date for performing processes and/or operationsdescribed with FIG. 8B above. An input device interface 104 receives auser input to the computer unit 100 from an input device 200 such as akeyboard, a mouse, a joystick, or a touch pad. An output deviceinterface 105 outputs data to an output device such as a display and arecording apparatus. A peripheral interface 106 performs data and/orsignal communication with an external device (for example, theMechanical portion 1).

In this way, in a medical support device that supports puncture havingtwo rotational elements, when inserting instruments at a plurality ofdifferent target positions, the instruments can be inserted at theirtarget positions without interfering with each other.

In this way, in a medical support device that supports puncture havingtwo rotational elements, when inserting instruments at a plurality ofdifferent target positions, the instruments can be inserted at theirtarget positions without interfering with each other.

The mechanical portion 1 may be fixed to the object with tape, adhesive,or the like. The base 15 may be provided with a part to which abelt-like instrument is attached, and the mechanical portion 1 may befixed to the object with a belt or the like. If the mechanical portion 1can be fixed to the object with bolts, the base 15 may be provided withholes into which bolts or other fixation elements are inserted.

The rotational elements do not necessarily have to be annular(ring-shaped) and arcuate, and only have to be mechanisms having twoorthogonal rotation axes.

The position detection units 6 do not necessarily have to be scale-like,and may be optical or electrical detectors, for example, encoders orpotentiometers. In that case, the present angle can be displayed on thepresentation unit 4 or the like.

In these embodiments, the movable portion of the first rotationalelement 11 can rotate ±180 degrees. However, the present invention isnot limited to this. The present invention can be applied even if therotation angle is less than ±180 degrees, such as ±145 degrees, ±90degrees, or ±45 degrees.

The range of movement of the movable portion of the second rotationalelement 12 can be wide. The wider the range of movement, the wider therange of puncture from the same installation position. However, in thepresent invention, this range is not limited as long as puncture targetpositions are within the range.

The shape of the needle guide 13 does not necessarily have to be acutout such as the triangular-shaped cutout as shown in FIGS. 3 and 4,and may be, for example, a tubular shape, a cylindrical shape, a troughshape, or such a shape that two parts hold an instrument there between(for example, two triangular, rectangular, or semicircular cutouts intwo parts of a needle guide that are held or hinged together).

In some embodiments, for simplification, a description has been given ofa case where only the needle guide 13 b is used. However, locations inthe vicinity of the origin cannot be punctured with only the needleguide 13 b. In such a case, by interchanging the needle guide 13 b withthe needle guide 13 a, the puncture of the vicinity of the origin ismade possible.

Although, in this embodiment, two types of needle guides 13 are shown,the present invention is not limited to this, and three, four, five ormore needle guides 13 of different angles may be used. In someembodiments, the needle guide 13 is inclined in a plane in which thesecond rotational element 12 rotates. However, as long as the straightline showing the guiding direction does not pass through theintersection 23 of the rotation axes of the two rotational elements, thepresent invention is not limited to this, and the needle guide 13 may beinclined in another direction, or may be translated.

The needle guide 13 may have a mechanism having a degree of freedom suchas those shown in FIGS. 10A to 10C, FIGS. 11A to 11C, and FIGS. 12A to12C so that the direction and angle of puncture can be changed freely.

FIGS. 10A, 11A, and 12A are front views, FIGS. 10B, 11B, and 12B areplan views, and FIGS. 10C, 11C, and 12C are side views. The needle guide13 is attached to the movable portion 12 b of the second rotationalelement 12, and is movable with only a predetermined degree of freedomowing to a groove 130 provided in the direction of degree of freedom anda fixing screw 131. By tightening the fixing screw 131, the needle guide13 can be fixed at a set angle.

FIG. 10 shows an example of a configuration that achieves a degree offreedom about a rotation axis parallel to the rotation axis of thesecond rotational element. FIG. 11 shows an example of a configurationthat achieves a degree of freedom about a rotation axis perpendicular tothe rotation axis of the second rotational element. FIG. 12 shows anexample of a configuration that makes it possible to translate theneedle guide 13 in the direction of the rotation axis of the secondrotational element without changing the puncturing direction.

Although the mechanisms of the needle guide 13 shown in FIGS. 10A to10C, FIGS. 11A to 11C, and FIGS. 12A to 12C are described independentlyof one another, they may be combined, or a mechanism having anotherconfiguration may be provided in order to achieve the same degree offreedom.

In some embodiments, only one combination determined by the interferenceanalysis unit 3 is presented on the presentation portion 4. However, thepresent invention is not limited to this. For example, four combinationsof straight lines and the distance between two straight lines in eachcombination may be presented so that the user can select whichcombination to use. Combinations causing interference are preferablyavoided.

The number of puncture target positions is two. However, the presentinvention is not limited to this. The number of puncture targetpositions may be three, four, five, or more. In that case, the number ofcombinations processed in the interference analysis unit 3 is 2 to thepower of n, where n is the number of targets.

With more target positions, the possibility that interference betweeninstruments occurs is increased. Therefore, one or more of the needleguide 13 can be configured to direct a needle to a point further awayfrom the origin, or a plurality of needle guides 13 can be configured toface in different directions so that they can be interchanged.

Second Embodiment Configuration

A second embodiment of the present invention will be described withreference to FIG. 6 to FIG. 8A. First, the schematic configuration of amechanical portion of a medical support device of this embodiment willbe described with reference to FIG. 6 and FIG. 7.

Mechanical Configuration

In FIG. 6, the structure of a movable portion in each rotational elementis omitted for simplification. The embodiments of the rotationalelements as described in U.S. Pat. Pub. 2014/027979 are hereinincorporated by reference. In use, a base 15 of a mechanical portion 1is first fixed and installed on an object to be punctured with a fixingunit (not shown). This includes, for example, the torso of a patient.

FIG. 7 is a sectional view of the configuration of FIG. 6 cut along theZY-plane.

A stationary portion of an annular, or ring shaped first rotationalelement 11 is attached to the fixing unit.

A stationary portion of an annular second rotational element 12 isattached to a movable portion of the rotational element 11 with asupporting portion 14 there between. The rotational element 11 and therotational element 12 are configured such that the rotation axis 22 ofthe movable portion of the second rotational element 12 is inclined at apredetermined angle α with respect to the rotation axis 21 of themovable portion of the first rotational element 11 and intersectstherewith at the origin of the XYZ coordinate.

A needle guide 13 (not shown) is attached to the movable portion of thesecond rotational element 12. As in the first embodiment, the needleguide 13 has a cutout. By inserting a needle-like instrument 10 alongthe cutout, the insertion direction of the instrument 10 is guided. Thestraight line 20 shows the direction in which the needle guide 13 guidesa needle-like instrument 10 in this embodiment.

As shown in the block diagram of FIG. 8B, the first rotational element11 and the second rotational element 12 are provided with positiondetection units 6 a and 6 b, with which the rotation angle of eachrotational element can be detected. The position detection units 6 a and6 b output the signal indicating the rotation angle of each rotationalelements 11 and 12. The signals output from the position detection units6 a and 6 b are input to the control portions 5 a and 5 b.

The first rotational element 11 is connected to a drive source 7 aprovided on the base by a transmission mechanism (not shown), and themovable portion is driven by the drive source 7 a. Similarly, the secondrotational element 12 is connected to a drive source 7 b provided on thesupporting portion 14 by a transmission mechanism (not shown), and themovable portion is driven by the drive source 7 b.

In some embodiments, markers 30 are attached to the medical supportdevice. Thus, some embodiments include at least three markers 30 thatcan be imaged by MRI, CT, or both MRI and CT are attached to themechanical portion 1. In some embodiments, four, five, or more markers30 are attached.

System Configuration and Operation

Next, a system in this embodiment will be described with reference tothe block diagram of FIG. 9. Here, the hard disc device 103 in FIG. 9stores a program code and a various type of date for performingprocesses and/or operations described with FIG. 8A below.

First, a tomographic image of the mechanical portion 1 installed on theobject is obtained by MRI or CT. A coordinate conversion unit 8 detectsthe plurality of markers 30 that are attached to or otherwise installedon the mechanical portion 1 from the tomographic image, and calculatesthe installation position and attitude of the mechanical portion 1 basedon the medical image from the positional relationship between theplurality of markers 30. The user specifies a plurality of targetpositions on the tomographic image. These positions are sent tocomputing unit 100 which includes a coordinate conversion unit 8, anglecalculation unit 2, interference analysis unit 3, and one or morecontrol portions 5 a and 5 b.

The coordinate conversion unit 8 converts the plurality of targetpositions specified on the tomographic image into a plurality of targetpositions in the coordinate system of the mechanical portion 1 on thebasis of the calculated installation position and attitude of themechanical portion 1, and outputs them to an angle calculation unit 2.

An angle calculation unit 2 finds two combinations of target angles ofthe two rotational elements for each of the input target positions, andoutputs them to an interference analysis unit 3. For example, when twotarget positions Pa (xa, ya, za) and Pb (xb, yb, zb) are input,combinations of target angles (θa1, θa2) and (θa1′, θa2′) for the targetposition Pa are output. Combinations of target angles (θb1, θb2) and(θb1′, θb2′) for the target position Pb are output.

The interference analysis unit 3 finds the equations of straight lines20 showing the directions in which needle-like instruments 10 areinserted, from the combinations of target angles input from the anglecalculation unit 2. Then, the interference analysis unit 3 finds thedistances between straight lines to different targets from the foundequations of straight lines.

For example, the interference analysis unit 3 finds the equations ofstraight line La and straight line La′ from the combinations of targetangles (θa1, θa2) and (θa1′, θa2′), and finds the equations of straightline Lb and straight line Lb′ from the combinations of target angles(θb1, θb2) and (θb1′, θb2′). Then, the interference analysis unit 3selects the combination that is largest in distance between straightlines from four combinations La-Lb, La-Lb′, La′-Lb, and La′-Lb′. In thisembodiment, La-Lb is selected as the combination that is largest indistance between straight lines. The largest distance is selected tominimize the possible interference. In other embodiments, it isunnecessary to select the combination that is largest in distance.

In this embodiment, the interference analysis unit 3 outputs targetangle θa1 to a control portion 5 a that is a control portion of thefirst rotational element 11. In addition, the interference analysis unit3 outputs target angle θb1 to a control portion 5 b that is a controlportion of the second rotational element 12.

The control portion 5 a controls the position of the movable portion ofthe first rotational element 11 by outputting a drive command to thedrive source 7 a provided to the first rotational element 11 on thebasis of target angle θa1 input from the interference analysis unit 3,and the position detection unit 6 a attached to the first rotationalelement 11. Specifically, the control portion 5 a outputs a drivecommand based on the difference between the present angle obtained fromthe position detection unit 6 a and target angles θa1, and performscontrol such that target angle θa1 is reached.

Similarly, the control portion 5 b controls the position of the movableportion of the second rotational element 12 by outputting a drivecommand to the drive source 7 b provided to the second rotationalelement 12 on the basis of target angle θb1 and the signal obtained fromthe position detection unit 6 b attached to the second rotationalelement 12.

Alternatively, instead of outputting a drive command to the controlportions of the rotational elements, the interference analysis unit 3may output the rotational position of the rotational elements and thenallow for manual adjustment of the rotational elements. In anotheralternative, the interference analysis unit 3 may output both the drivecommand to cause the rotation of the rotational elements and also therotational positions so that the automated rotation may be verified bythe user.

As a result, the needle guide 13 faces the target position Pa. Byinserting a needle-like instrument 10 a along the cutout of the needleguide 13 in this attitude, the instrument can be inserted at the targetposition Pa.

Next, in order to puncture the target position Pb, with the instrument10 a remaining inserted, the drive sources 7 a and 7 b are driven suchthat the rotational elements 11 and 12 are at the target angles θb1 andθb2 thereof. As a result, the needle guide 13 faces the target positionPb. By inserting a needle-like instrument 10 b along the cutout of theneedle guide 13 in this attitude, the instrument 10 b can be inserted atthe target position Pb without interfering with the instrument 10 a.

Third Embodiment

The third embodiment of the present invention will be described withreferences to FIG. 13 to FIG. 14. First, the apparatus of usinginterchangeable needle guides of different designs will be describedwith reference to FIG. 13. However, the needle guides as described inthe first and second embodiments may also be combined with the teachingsof this embodiment.

In FIG. 13, an example of apparatus of a detachable needle guide ispresented. For simplicity, only the two mating surfaces 24 and 25 areshown. When combined, these surfaces form a second rotational element 12as described, for example, in FIG. 6. The lower mating surface 24 isattached to the first rotational element or base (not shown).

The needle guide can be attached and detached at the will of the user.For example, the needle guide can be slid into and out of a groove, ontoa pin-like structure, or it can contain a snap closure for securing andremoving from the apparatus. The removable mating surface 25 of therotational element 12 includes a needle guide 13. The removable matingsurface of the needle guide 25 can be attached and removed from a secureposition by pressing bosses 26 on the top of the lower mating surface 24into holes 27 on the upper mating surface of the needle guide 25.

Each needle guide 13 can have a unique shape such that a needle-likeinstrument 10 can be inserted without colliding with previously insertedneedles.

In one exemplary embodiment, the cutouts on each needle guide can beformed so they rest at different heights. This will guide the needle toan entry point which would be above or below the intersection of therotation axis of the two rotational elements 11 and 12. In FIG. 14, twoneedle guides 13 and 13 b of different heights are overlaid. In thisfigure, the example shows the different points the guide 13 meets withthe rotational axis of the lower ring 21.

Fourth Embodiment

A fourth embodiment of the present invention, a system of using a uniqueand preselected needle guide for each individual needle inserted, willbe described with reference to FIGS. 15A-15C.

During insertion of multiple needles, each needle guide can be used in apredetermined order. These needle guides can vary in design to ensureeach needle has a unique insertion path and will not interfere withpreviously inserted or future needles.

The user can determine which needle guide to use by markings on theneedle guide that are unique to each design.

The markings can be include numbers, letters, colors, or names, or anyvariation or combination there-of. FIG. 15 shows an example of threedifferently designed needles guides each having a unique marking on themfor identification.

The procedural workflow or software can tell the user which sequence touse.

The software can modify the kinematics algorithm to adjust for theunique design of each needle guide.

The user 19 will select the first needle guide 13, as denoted by theworkflow, and attach it to the second rotational element 12. The user 19will sent the target to the controller through the software and therobot will rotate the rotational elements to align the first needleguide to the target. The user 19 will then insert the needle through theguide until it reaches the target. After the needle reaches the target,the user 19 will remove the first needle guide 13 from the secondrotational element 12 and discard of it. The user 19 will then take thesecond needle guide 13, as denoted by the workflow, and attach it to thesecond rotational element 12. The user 19 will send the target to thecontroller through the software and the robot will rotate the rotationalelements to align the second needle guide to the target. The user willnot have to change any settings of the software since the softwarealready knows the order the needle guides will be used in. The user willinsert the needle and repeat this process until all needles are placed.

Fifth Embodiment

A fifth embodiment of the present invention will be described withreferences to FIG. 16 to FIG. 17.

First, the system of using a user-selected needle guide for eachindividual needle inserted will be described.

During insertion of multiple needles, the user can decide which needleguide to use so the insertion of the next needle will not collide withpreviously inserted needles. Alternatively, the needle guides can beprovided in a kit with a predetermined order, where each of the needleguides is provided such that when used in order, the inserted needleswill not collide with each other, even without the need to move thepatient's skin or prior needle.

The device and associated software can detect which needle guide isinserted and update the kinematics algorithm to match the current guide.

Next, the system of sensing which needle guide design for each needleinserted will be described with reference to FIG. 16 to FIG. 17.

In FIG. 16, an example of a needle guide used in a system where theneedle guide identity is sensed using a key design 28 is shown. Forsimplicity, only the needle guide and key 28 is shown. In this design,different pins are depressed depending on the shape of the key 28attached to the needle guide. Based upon the combination of which pinsare pressed, the identity of the needle guide can be deciphered.

In FIG. 17, an example is shown of a system where an optical sensor 29detects a unique marking on the needle guide to identify which is beingused. For simplicity, only the marking is shown. In this design, thevisual markings are detected by an optical sensor 29 and the softwarecan determine which needle guide design matches the detected markings.

In other embodiments, other ways of determining which needle guide isprovided in the medical support device may be used. These methods mayinclude other types of sensors, pins, or other structures that allowinformation to be provided to the kinematics algorithm so the insertionof the needle with the specific holders can be defined.

Sixth Embodiment

As shown in FIG. 18, a pivot point 30 exists where, when using a needleguide 13, a needle or other needle like instrument must pass through inorder to reach all target positions within a reachable volume 32. Theneedle reachable volume 32 is a cone shaped volume where the tip of thecone is located at the pivot point 30 and extends into the patient. Thepivot point 30 can be located in a number of locations relative to theskin 34 of the patient. For example the pivot point 30 can be above theskin 34, on the skin 34, or within the patient. This can be defined bythe design of the medical support device and optionally any other deviceor component mounted on the patient. For example, the addition of an RFcoil beneath the medical support device where the device initially has apivot point at the skin moves the pivot point to a position above theskin's surface. If the pivot point 30 coincides with a location on theskin 34 of the patient (as shown in FIG. 18) or within a patient thenthis prevents accurate targeting when using multiple needles with aneedle guide 13. For insertion, each needle path must be altered to movearound prior needles because prior needles will pass through the pivotpoint 30. The pivot point 30 can also be offset from intersection 23. Inthe case where the pivot point 30 is located above the patient a desiredneedle path for multiple needles through the pivot point can bemaintained even when using multiple needles without the needlesoverlapping. For example after the first needle is placed, user 19 cantilt the first needle to move the needle out of the way while insertingthe next needle. Due to the first needle already being located withinthe patient, the tip will be stationary and just the portion of theneedle remaining outside the patient will bend away from pivot point 30.

Height Change Discussion

In the next embodiment, as indicated in FIG. 18B, the medical supportdevice has a remote center of motion (RCM) which is located above thesubject when placed on the subject. The height of the needle guide ischanged, thus modifying the pivot point 30 of the needle. As shown inFIG. 18B, if the same angle is maintained and the height is shifted upin the Y direction then the pivot point 30 will shift upwards. Thisshift has multiple effects. One effect is the shift in initial puncturepoint 36 due to shift of initial needle path 38. A new puncture point 40is created following needle path 42. For example if the pivot point 30is originally at the surface of the skin, and then the pivot point 30 isshifted upward then the initial puncture point 36 will be shiftedoutward. Another effect is the change in reachable volume 32 if weassume a fixed needle length. By changing the pivot point the reachablevolume 32 is shifted. Thus, in use, a first needle-like instrument isinserted at a first puncture starting point and then the medical supportdevice (or a portion of the medical support device) is moved upwards,away from the patient's skin. Next, a second needle-like instrument isinserted into a second puncture starting point that is different fromthe first puncture starting point.

Angle Change Discussion

In the embodiments where the angle of the needle guide is changed, thereare multiple effects. These effects are similar to the effects whenchanging the height of the needle guide as described in the previousembodiment. If the height is maintained, the shift in angle will createnew puncture points. For example in FIG. 18C, θ represents the originalangle of initial needle path 38 with respect to the surface of the skin34 when the needle enters the skin at the first puncture starting point36 and Φ represent the angle between a second needle path 42 and skin 34created by modifying the needle guide angle. With the modified angle,instead of entering the patient at the initial puncture starting point36, the entry point is shifted outward to a second puncture startingpoint 44. Another effect can be seen when the needle lengths aremaintained. The shape of the cone that represents the reachable volume32 of the needle is modified. In the case with angle θ the cone isnarrower and can reach deeper past the surface. In the case with angle Φthe cone is wider and reaches a volume that is shallower. Thus, in use,a first needle-like instrument is inserted at a first puncture startingpoint where the needle guide holds the needle at an angle θ. A secondneedle-like instrument is inserted via a second needle guide that holdsthe needle at angle Φ. This second needle is inserted into a secondpuncture starting point that is different from the first puncturestarting point.

Combination of Angle Change and Height Change of Needle Guide

It is apparent that a combination of changing the height and angle ofneedle guide 13 will result in the combined effects of each individualchange. For example the pivot point 30 can be maintained while changingthe shape of the reachable volume of the needle by combining the effectsof modifying the needle guide height and angle.

Example: Calculations

In the configuration of this example, the inclination a of the secondrotational element is set to 20 degrees, and the diameter of theneedle-like instruments 10 is set to 2 mm. The initial position of thefirst rotational element 11 is set to such a position that the secondrotation axis 22 is in the YZ plane. The initial position of the secondrotational element 12 is set to such a position that, when a needleguide 13 (different from the needle guide in this description)intersecting with the intersection 23 of rotation axes is attached, astraight line showing the guiding direction coincides with the Y-axis.The straight line showing the guiding direction of the needle guide 13is set to be a straight line passing through two points (0 mm, 50 mm, 0mm) and (5 mm, 0 mm, 0 mm) on the XYZ coordinate in a state where themechanical portion 1 is at the initial position. This straight line isexpressed by the following equation (1) using parameter t:

$\begin{matrix}\begin{Bmatrix}{x = {5t}} \\{y = {50 + {{- 50}t}}} \\{z = 0}\end{Bmatrix} & (1)\end{matrix}$

Two target positions Pa (xa, ya, za) and Pb (xb, yb, zb) are set to Pa(10 mm, −50 mm, 20 mm) and Pb (−5 mm, −40 mm, 10 mm).

When target position Pa is input into the angle calculation unit 2, thefollowing combinations of target angles of the two rotational elementsare output:

-   (θa1=−91.11 degrees, θa2=40.23 degrees)-   (θa1′=144.24 degrees, θa2′=−99.09 degrees)

Similarly, when target position Pb is input into the angle calculationunit 2, the following combinations of target angles of the tworotational elements are output:

-   (θb1=−124.11 degrees, θb2=8.87 degrees)-   (θb1′=70.98 degrees, θb2′=−75.17 degrees)

Next, the interference analysis unit 3 finds straight lines La, La′, Lb,and Lb′ showing the guiding direction of the needle guide 13 in eachattitude from the configuration of the mechanical portion 1 and theinput combinations of target angles of the rotational elements.

Then, the interference analysis unit 3 finds the distance between twostraight lines in each of four possible combinations La-Lb, La-Lb′,La′-Lb, and La′-Lb′. In this example, the distance between two straightlines in each combination is as follows:

La-Lb: 3.65 mm

La-Lb′: 4.45 mm

La′-Lb: 8.93 mm

La′-Lb′: 2.28 mm

In this embodiment, the combination that is largest in distance betweentwo straight lines is selected. Therefore, La′-Lb is selected. On thebasis of this, the drive sources 7 a and 7 b drive the rotationalelements toward the target angles.

Since the diameter of instruments 10 is set to 2 mm, even if thisdiameter is taken into account, two needle-like instruments 10 a and 10b are 6.93 mm away from each other even when they are closest to eachother, and therefore they can puncture their respective target positionswithout interfering with each other.

In this embodiment, the angle calculation unit 2, the interferenceanalysis unit 3, and the control portion 5 are described as separateunits. However, this is a conceptual separation. For example, theseunits may be incorporated in a CPU as pieces of software at the sametime. Alternatively, a single software program may perform multiplefunctions. In some embodiments, one or more of the angle calculationunit 2, the interference analysis unit 3, and the control portion 5 is adedicated piece of firmware.

In the embodiment described above, the number of puncture targetpositions is two. However, the present invention is not limited to this.The number of puncture target positions may be three, four, five ormore. As more needles are used, the possibility that interferencebetween the various instruments occurs is increased. Therefore, theneedle guide 13 can be caused to face a point further away from theorigin, or a plurality of needle guides 13 facing in differentdirections can be prepared. Thus, it is contemplated that a needleholder having needle guides 13 with only a small deflection from theintersection of the rotation axis of the two rotational elements may beused when only a few needles need to be place and needle guides having agreater deflection are used when more needles are indicated in aprocedure. The needle placement apparatus can include interchangeableneedles guides so the different to account for differences needed in thedeflection.

Although a plurality of needle guides 13 facing in a plurality ofdirections are interchanged, the present invention is not limited tothis. For example, needle guides facing in different directions may beprovided at the positions of 0 degrees and 180 degrees of the movableportion of the second rotational element, and which needle guide to usemay be selected on the basis of the analysis result of the interferenceanalysis unit 3.

The needle guide 13 may have, as in the first embodiment, a mechanismhaving a degree of freedom such as those shown in FIGS. 10A to 10C,FIGS. 11A to 11C, and FIGS. 12A to 12C so that the direction of puncturecan be changed freely.

Although the markers 30 are disposed on the base 15 as shown in FIG. 6in this embodiment, the present invention is not limited to this, andthe markers 30 may be disposed on the first rotational element 11 or thesecond rotational element 12. In this case, it may be necessary todetect the angle of each rotational element, and to record the positionof each marker 3 in the coordinate system of the support device. Inother embodiments the markers may be used, for example, for identifyingkinds of needle, diameter, cryo-, radio, datum height of needleinsertion, etc.

In this embodiment, the rotational elements 11 and 12 and the drivesources 7 a and 7 b are connected by transmission mechanisms. Thetransmission mechanisms can be constructed by using, for example, gearsor a timing belt.

The medical support device is designed to be placed on a patient. Thusin in use in some embodiments, the first needle-like instrument isguided by the needle guide and is inserted into the body of a patient ata pre-determined angle and having a predetermined first puncturestarting point where it punctures the patient's skin.

In one example of an embodiment of the invention, the medical supportdevice is placed on a patient above the patient's liver. An MRI image isobtained while the medical support device is affixed to the patient. Aninsertion trajectory is planned using the initial MRI image. Theplanning may include, for example, selecting different locations in aliver lesion for radio frequency ablation by touching the positionpoints on a touch screen showing the MRI image. The coordinateconversion unit converts these positions on the image into targetpositions in the coordinate system. The angle calculation unit 2 thencalculates combinations of target angles of the two rotational elementsthat provide correct needle insertion parameters for each the inputtarget positions, and outputs the parameters to an interference analysisunit 3. Then, the medical support device is instructed to move theneedle-like instrument guide into the first position. This probelocation may be confirmed with an intra-procedural image. The user maythen verify the location and insert the needle-like device into thepatient's liver. Optionally, the needle-like device may be partiallyinserted and a confirmation image taken prior to full insertion of theneedle-like instrument.

Embodiment(s) of the present invention can also be realized by acomputer of a system or apparatus that reads out and executes computerexecutable instructions (e.g., one or more programs) recorded on astorage medium (which may also be referred to more fully as a‘non-transitory computer-readable storage medium’) to perform thefunctions of one or more of the above-described embodiment(s) and/orthat includes one or more circuits (e.g., application specificintegrated circuit (ASIC)) for performing the functions of one or moreof the above-described embodiment(s), and by a method performed by thecomputer of the system or apparatus by, for example, reading out andexecuting the computer executable instructions from the storage mediumto perform the functions of one or more of the above-describedembodiment(s) and/or controlling the one or more circuits to perform thefunctions of one or more of the above-described embodiment(s). Thecomputer may comprise one or more processors (e.g., central processingunit (CPU), micro processing unit (MPU)) and may include a network ofseparate computers or separate processors to read out and execute thecomputer executable instructions. The computer executable instructionsmay be provided to the computer, for example, from a network or thestorage medium. The storage medium may include, for example, one or moreof a hard disk, a random-access memory (RAM), a read only memory (ROM),a storage of distributed computing systems, an optical disk (such as acompact disc (CD), digital versatile disc (DVD), or Blu-ray Disc (BD)™),a flash memory device, a memory card, and the like.

In referring to the description, specific details are set forth in orderto provide a thorough understanding of the examples disclosed. In otherinstances, well-known methods, procedures, components and circuits havenot been described in detail as not to unnecessarily lengthen thepresent disclosure.

Exemplary embodiments will be described below with reference to theseveral drawings, wherein like reference numerals designate identical orcorresponding parts throughout the several views and embodiments.Accordingly, descriptions of such parts with like reference numeralswill not be repeated with respect to multiple figures.

It should be understood that if an element or part is referred herein asbeing “on”, “against”, “connected to”, or “coupled to” another elementor part, then it can be directly on, against, connected or coupled tothe other element or part, or intervening elements or parts may bepresent. In contrast, if an element is referred to as being “directlyon”, “directly connected to”, or “directly coupled to” another elementor part, then there are no intervening elements or parts present. Whenused, term “and/or”, includes any and all combinations of one or more ofthe associated listed items, if so provided.

Spatially relative terms, such as “under” “beneath”, “below”, “lower”,“above”, “upper”, “proximal”, “distal”, and the like, may be used hereinfor ease of description to describe one element or feature'srelationship to another element(s) or feature(s) as illustrated in thevarious figures. It should be understood, however, that the spatiallyrelative terms are intended to encompass different orientations of thedevice in use or operation in addition to the orientation depicted inthe figures. For example, if the device in the figures is turned over,elements described as “below” or “beneath” other elements or featureswould then be oriented “above” the other elements or features. Thus, arelative spatial term such as “below” can encompass both an orientationof above and below. The device may be otherwise oriented (rotated 90degrees or at other orientations) and the spatially relative descriptorsused herein are to be interpreted accordingly. Similarly, the relativespatial terms “proximal” and “distal” may also be interchangeable, whereapplicable.

As used herein, the terms “about” or “approximately” mean within anacceptable range for the particular parameter specified as determined byone of ordinary skill in the art, which will depend in part on how thevalue is measured or determined, e.g., the limitations of the samplepreparation and measurement system. For example, “about” can mean arange of up to 20% of a given value, and more preferably means a rangeof up to 10%.

The terms first, second, third, etc. may be used herein to describevarious elements, components, regions, parts and/or sections. It shouldbe understood that these elements, components, regions, parts and/orsections should not be limited by these terms. These terms have beenused only to distinguish one element, component, region, part, orsection from another region, part, or section. Thus, a first element,component, region, part, or section discussed below could be termed asecond element, component, region, part, or section without departingfrom the teachings herein.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting. As used herein, thesingular forms “a”, “an”, and “the”, are intended to include the pluralforms as well, unless the context clearly indicates otherwise. It shouldbe further understood that the terms “includes” and/or “including”, whenused in the present specification, specify the presence of statedfeatures, integers, steps, operations, elements, and/or components, butdo not preclude the presence or addition of one or more other features,integers, steps, operations, elements, components, and/or groups thereofnot explicitly stated.

In describing example embodiments illustrated in the drawings, specificterminology is employed for the sake of clarity. However, the disclosureof this patent specification is not intended to be limited to thespecific terminology so selected and it is to be understood that eachspecific element includes all technical equivalents that operate in asimilar manner. It is apparent that variations and modifications of theinvention can be made without departing from the spirit or scope of theinvention. Upon further study of the specification, further aspects,objects and advantages of this invention will become apparent to thoseskilled in the art.

While the above description provides examples and specific details ofvarious embodiments, it will be appreciated that some features and/orfunctions of the described embodiments admit to modification withoutdeparting from the scope of the described embodiments. The abovedescription is intended to be illustrative of the invention, the scopeof which is limited only by the language of the claims appended hereto.The scope of the following claims is to be accorded the broadestinterpretation so as to encompass all such modifications and equivalentstructures and functions.

What is claimed is:
 1. A medical support device, comprising: a firstrotational element having a first rotation axis and a first rotationaldegree of freedom; a second rotational element having a second rotationaxis and a second rotational degree of freedom that is attached to thefirst rotational element wherein the second rotation axis intersectswith the first rotation axis; and at least one needle guide that isattachable to the second rotational element and is configured to guidethe direction of insertion of a needle-like instrument, wherein the atleast one needle guide includes at least one guide portion that guides afirst needle-like instrument through a first puncture starting point andguides a second needle-like instrument through a second puncturestarting point which is different from the first puncture startingpoint, wherein, the at least one needle guide is in a first positionwhen guiding the first needle-like instrument and in a second positionwhen guiding the second needle-like instrument, or a first needle guideincludes a first guide portion that guides a needle-like instrumentthrough the first puncture starting point and a second needle guideincludes a second guide portion that guides a needle-like instrumentthrough the second puncture starting point.
 2. The medical supportdevice according to claim 1, comprising at least a first needle guideand a second needle guide that simultaneously or sequentially attach tothe second rotational element.
 3. The medical support device accordingto claim 2, wherein the first needle guide and second needle guide eachhave visible or electronic identification markers that distinguish theneedle guides.
 4. The medical support device according to claim 1,wherein the first puncture starting point and the second puncturestarting point are different due to different angles of insertion of theneedle guide in the first position and the second position.
 5. Themedical support device according to claim 1, wherein different locationof the first puncture starting point and the second puncture startingpoint is due to different heights of the needle guide or guides abovethe plane defined by the first and second puncture starting points inthe first position and the second position.
 6. The medical supportdevice according to claim 1, further comprising an angle calculationunit configured to determine possible angles of the two rotationalelements on the basis of specified target positions and the arrangementof two rotational elements and the needle guide.
 7. The medical supportdevice according to claim 6, further comprising an interference analysisunit configured to determine, with respect to the specified differenttarget positions, straight lines showing insertion directions from thepossible angles of the two rotational elements with respect to eachtarget position found by the angle calculation unit, and to determinesuch combinations of insertion directions without interference that thedistance between straight lines is greater than or equal to the diameterof the needle-like instrument used.
 8. The medical support deviceaccording to claim 7, wherein the interference analysis unit selects acombination of insertion directions that is largest in the distancebetween straight lines or any one combination from the combinations ofinsertion directions without interference.
 9. The medical support deviceaccording to claim 7, further comprising a presentation unit configuredto present the combinations of insertion directions withoutinterference.
 10. The medical support device according to claim 6,wherein the medical support device comprises the two or more needleguides facing in different directions at the same time, and one of thetwo or more needle guides facing in different directions faces in adirection passing through the intersection of the rotation axes of thetwo rotational elements, and the others face in such a direction thatthe distance from the intersection is greater than or equal to thediameter of the needle-like instrument used.
 11. medical support deviceaccording to claim 1, wherein the needle guide has a degree of freedom,and the direction in which an instrument is guided is changeable. 12.The medical support device according to claim 1, wherein the needleguide is configured to release the needle-shaped instrument afterinsertion.
 13. The medical support device according to claim 1, whereinthe two rotational elements each have a position detection unit.
 14. Themedical support device according to claim 14, wherein at least one ofthe two rotational elements has a drive unit, and each rotationalelement is moved to an angle that is found by the angle calculation unitand selected by the interference analysis unit, on the basis of positioninformation obtained by the position detection unit.
 15. The medicalsupport device according to claim 1, further comprising a medicalimaging machine, and at least three markers that can be imaged by themedical imaging machine.
 16. A medical support device, comprising: atleast one rotatable portion having at least one rotational degree offreedom and at least one needle guide attached to the rotatable portionand having a guide portion, which is configured to: (a) guide thedirection of insertion of a needle-like instrument and (b) separate fromthe needle-like instrument after insertion of the needle-likeinstrument, wherein the guide portion, when the needle guide ispositioned in a first position, is configured to guide the needle-likeinstrument to a first puncture starting point wherein the guide portion,when the needle guide is positioned in a second position, or wherein theguide portion of a second needle guide is configured to guide theneedle-like instrument to a second puncture starting point which isdifferent from the first puncture starting point.
 17. The medicalsupport device according to claim 15, wherein the guide portion isconfigured to separate from the needle-like instrument via movement outof a notch in the guide portion.
 18. A method comprising: attaching amedical support device to a patient, wherein the medical support devicecomprises a first rotational element, second rotational element, and atleast two needle guides, defining at least a first location and a secondlocation in the patient for therapeutic intervention based on an imagedata, attaching a first needle to a first needle guide, attaching thefirst needle guide to the medical support device, instructing themedical support device to rotate the first rotational element and thesecond rotational element to a position defined by the first locationfor therapeutic intervention, inserting the first needle into thepatient, releasing the first needle from the medical support device,attaching a second needle to a second needle guide and attaching thesecond needle guide to the medical support device, instructing themedical support device to rotate the first rotational element and thesecond rotational element to a position defined by the second locationfor therapeutic intervention, inserting the second needle into thepatient, wherein the second needle does not contact the first needleduring insertion into the patient, and releasing the second needle fromthe medical support device.